Saturday, June 20, 2009

In a small room at the Escambia County Jail, male inmates let their creativity run free. Using paint and pencils, some participants in the Captured Art program create idyllic scenes of bright skies and blue oceans. Others incorporate darker images —skulls and tombstones — to tell a story.

Several of those original works are now on display, through July 24, at Gallery 88, inside the WUWF Studios on University Parkway.

The Captured Art program began at the Escambia County Jail in 2007 with a volunteer teacher and donated supplies. According to Sybil Sahuque and Sharon Giraud, who began the program, its initial goal was to aid inmates with mental health issues.

"We're amazed at how far we've come since we started," said Sahuque, who serves as the program's sole art instructor. "Now there is a waiting list to get in."

"We never thought it would take off the way it did," Giraud said. "To think that we began with paper and mechanical pencils as only art supplies, we've certainly come a long way."

The popular program, funded mainly through donations of money, materials and the sale of participants' art work, is now open to inmates with exemplary behavior who pass an arts aptitude test. Because of space constraints, 10 or fewer men are accepted into the program at a time.

Sharon Gossett, a Sheriff's Department employee who works with the program, said that Captured Art brings about positive changes in participants.

"Their self-esteem has been encouraged, they want to further their education in art and maybe begin a career with what they have learned," she said. "And they have asked if they can invite the younger inmates into the program to try and mentor to them so that they do not make the same mistakes in life."

Former inmate Clarence Williams, 52, said he found self-worth through the program.

Recently released from jail, Williams was a guest of honor at the "Art from the Inside Out" opening reception Thursday.

"I always knew how to draw, but I never considered myself an artist until I got in the art group in prison," he said. "It helped me realize that I can do positive things with my life. It has made me want to do something with my art, now that I'm out."

Lynne Marshall, director of promotions & outreach at WUWF Public Media, said that the "Art from the Inside Out" exhibit is a perfect means to showcase the prison's unique art program.

"We've done several shows that highlight an issue or cause, such as hospice or breast cancer awareness," Marshall said. "When I heard about the Captured Art program and went to the jail and visited these men, I was just so moved by their stories and their work. I felt it was something that we needed to share with the community."

Susan Watson, regional director of the American Civil Liberties Union of Florida, hopes the exhibit will raise community awareness regarding the need for a mental health court.

"It's really important that we take a look at how to treat inmates with mental illness," Watson said. "The exhibit is also an opportunity to show the community some of the good things that are happening at the jail. This is a humane program that allows inmates to express themselves in a positive manner."

Sahuque, Giraud and Watson hope that the exhibit will inspire artistic volunteers to start a similar program for female inmates.

"Some wonderful things have come out of the Captured Art program," Watson said. "They should be shared."

Journal State House BureauHe banged his head against the wall until his teeth were loose, says one investigator. He clawed at his chest to get the devil out.

So, prison officials moved James Davis-Reed to a special segregation cell within the “Super Max” unit of the Adult Correctional Institutions on March 27.

It is the safest place the prison offers mentally-ill inmates.

The six-cell “observation and stabilization” area is relatively quiet. Prisoners are held in isolation under 24-hour video surveillance. Psychiatrists visit three times a week.

It’s more common for staff to use restraints on suicidal inmates there, as was the case for Davis-Reed that Thursday morning.

His final hours are still under investigation.

Prison officials have confirmed he was locked in four-point restraints — bound to his bed at the wrists and ankles — “for a short period” in the morning. After the restraints were removed, 24-year-old Davis-Reed was left alone and naked — he had stripped off his gown — under motion-activated video surveillance, in a 7-foot by 10-foot cell.

A prison spokeswoman said that Davis-Reed “was on the highest level of observation.” She could not say, however, when guards realized he had stopped breathing.

Just one state official, Mental Health Advocate H. Reed Cosper, has been willing to publicly discuss the young man’s death in detail.

“He rolled himself up into a fetal kind of ball, which is kind of a regressive behavior for a really sick guy. And he managed to roll his head into a crevice between the bed and the wall, and he couldn’t get out,” said Cosper, among those investigating the incident. “He suffocated, kind of like being crucified. He didn’t suffocate in two minutes. He suffocated in 45 minutes, or 30, I don’t know.” It’s unclear if Davis-Reed was trying to kill himself.

The state police are investigating, as is the ACI. The medical examiner has ruled the death was the result of “positional asphyxia.”

No one disputes these basic facts: James Davis-Reed left the prison in an ambulance and was pronounced dead at Rhode Island Hospital on March 27. He died after spending 35 days at the ACI, transferred there after spending the previous 1,273 days in the forensic unit of the state hospital for mentally-ill prisoners.

“There are mentally-ill people for whom prison is toxic,” Cosper says. “This man was too fragile to be in prison.”

Department of Corrections Director A.T. Wall says his staff did the best it could.

“We can never say ‘no’ when a court sentences an offender to us. On any given day we have hundreds of mentally-ill offenders — diagnosed, in treatment, and on medication. The overwhelming majority adjust and are doing fine in the population,” Wall said. “Our staff worked very hard with James and the treating psychiatrist was distraught over his death, as were many of the staff that worked with him. They grieved when he died.”

JAMES DAVIS-REED had largely cooperated with the doctors after his arrest four years ago.

There was little doubt that he was a dangerous man.

He had traveled through the night of June 27, 2005, from Far Rockaway, N.Y., to Rhode Island to find his ex-girlfriend, Tiffany Joiner. He snuck in through her kitchen window at the Oxbow Farm housing complex in Middletown just after 9 a.m., and found a 10-inch kitchen knife in a drawer.

He first attacked Joiner’s 14-year-old brother, who was watching TV on the couch. Davis-Reed stabbed the boy several times in the neck, chest and back before chasing Joiner and her new boyfriend up the stairs.

The couple suffered minor stab wounds as they tried to barricade themselves in an upstairs bathroom.

The police arrived before anyone was killed.

They chased Davis-Reed through the apartment and out the back door before pinning him to the ground.

Middletown police officer Mark Minnella’s narrative described the moment immediately after the arrest: “The subject was crying and covered in blood. I asked the subject why he stabbed the other party, and his reply was, ‘I love ’em like a brother.’ ” Everyone survived the attack, including Joiner’s 5-year-old brother, who was taken to the hospital to be treated for shock.

The State of Rhode Island took custody of Davis-Reed later that day, June 28, 2005, when he was 20 years old.

His first stop was the state prison.

A judge ordered a mental competency exam less than two months later. On Aug. 26, Davis-Reed was deemed incompetent to stand trial and moved to the forensic unit of Eleanor Slater Hospital, the locked unit for mentally-ill criminals.

An incompetent defendant, according to state law, is someone who “is unable to understand the character and consequences of the proceedings against him or her and is unable to properly assist in his or her defense.”

The goal is to restore the defendant to competency through treatment, said Stacy P. Veroni, chief of the criminal division for the attorney general’s office. “Someone can be insane and competent to stand trial. … It doesn’t have to do with his mental state at the time he committed the offense. It has to do with whether the defendant can generally understand the court process.”

Davis-Reed’s public defender, Paul Tondreau, says all involved with the case agreed that his client was not fit for trial. Tondreau said the forensic unit was more appropriate for Davis-Reed. “He was getting treatment there in a setting that was preferable to the prison.”

He responded well in the small hospital unit, where he was medicated and received constant attention. After more than a year of treatment, he was reevaluated and on Dec. 4, 2007, he was deemed competent to stand trial, according to court records. Tondreau did not challenge the competency ruling, but requested that Davis-Reed be allowed to stay at the hospital until the case was resolved in court. The attorney general’s office did not object, and Davis-Reed would spend two more years in Eleanor Slater.

While still living in the mental hospital, Davis-Reed ultimately pleaded guilty to five felony counts and signed off, in September 2008, on a plea bargain that capped his prison time at 15 years.Tondreau did not raise the insanity defense, which might have kept Davis-Reed out of prison. “The client has the final say,” the public defender said recently. “It’s his decision.”

Superior Court Justice Melanie Wilk Thunberg accepted Davis-Reed’s plea bargain on Feb. 20, 2009, and ordered him to the ACI. Tondreau did not object. After more than three years in a state mental hospital, Davis-Reed was transferred to the prison that day.

Prison officials had less than 24 hours’ notice he was coming.

THE ADULT Correctional Institutions holds Rhode Island’s largest collection of the mentally ill.

One day in mid-May, at least 567 inmates, or 23 percent of the “sentenced male population,” were prescribed psychotropic medication for mental illness, according to figures provided by the Corrections Department. These do not include the intake center or the women’s unit. Of the 567 inmates, 213 were taking antipsychotic drugs for the most serious diagnoses, such as schizophrenia.

Despite the numbers, the prison’s clinical director, Frederic C. Friedman, said the ACI has “a small number of people with serious mental illness. The number of truly psychotic is small.”

It’s unclear if Davis-Reed was among the “truly psychotic.” State officials have refused to discuss his health, citing medical privacy laws. And court records relating to mental competency have been sealed.

After leaving the 20-bed mental hospital, he spent his first 34 days at the intake center — a chaotic, crowded environment that holds 1,148 inmates.

Friedman said Davis-Reed spoke to a “weekend psychiatrist within 24 hours” and visited a psychiatrist and social workers “several times” in the subsequent weeks, typical treatment for inmates.

Cosper, the mental health advocate, has suggested that ACI doctors may have changed Davis-Reed’s medications after the transfer. Citing medical privacy laws, prison officials refused to answer that question.

The ACI has partnered with the University of Rhode Island’s College of Pharmacy to control ballooning medication costs by switching to generic drugs in many cases, a collaboration that prompted a national award less than two weeks after Davis-Reed’s death.

Taxpayers spent $180,857 on antipsychotic medication for prisoners between February and April of this year, according to information Friedman provided.

He said he works to ensure that prison psychiatrists are aware of cheaper drug options, but says that specific prescription decisions are left to inmates’ psychiatrists.

“I’m concerned that in this area of fiscal restraints, the impression is being created that we sacrificed, sent somebody to the bottom line. It simply isn’t true,” said Wall. “The clinical staff was actively working with this guy and he was working with us.”

It’s unclear what triggered Davis-Reed’s deterioration. He went downhill relatively quickly at the ACI — after steadily improving over three years at Eleanor Slater Hospital.

“He had engaged in some self-injurious behavior which called upon us to place him in a smaller setting,” Wall said, declining to describe the behavior. It was Cosper who said that Davis-Reed had been knocking his head against the wall to the point of loosening his teeth, and clawing at his chest “to get the devil out.”

The smaller setting was the ACI’s observation and stabilization unit within maximum security, a special area established roughly three years ago for those with the most serious mental problems.

State law affords prison officials another option. In extreme cases, the corrections director or the director of the state Department of Mental Health, Retardation and Hospitals may file a court petition to have a mentally-ill prisoner transferred to Eleanor Slater Hospital.

Corrections officials could account for a handful of such petitions in recent years; MHRH couldn’t detail any.

The Department of Corrections did not file a petition in Davis-Reed’s case, though they acknowledge that the prisoner had become a danger to himself.

“He is by no means the only inmate who has been self-injurious in our setting. Sadly, we’re accustomed to seeing that behavior. It may not be routine, but it is not particularly rare,” Wall said. “And he had been with us for only five weeks. Lots of mentally-ill inmates have trouble settling down at first whenever there’s a change in circumstance.”

JAMES DAVIS-REED is among dozens of inmates who have died while in the care of Rhode Island’s prison system in recent years.

Altogether, 62 people died at the ACI since Jan. 1, 2000, according to data provided by the Department of Corrections. It’s difficult to say how many were mentally ill.

Davis-Reed is the only one listed as having died from “positional asphyxia.” But the prison details 13 suicides over that time, including 11 by hanging. Four inmates died from drug overdoses or acute drug withdrawal.

Rhode Island is hardly the only state in which prisoners die.

In 2006, 8 inmates died in the Ocean State, 39 died in the Massachusetts’ state prison system, 25 in Connecticut, 7 in Vermont, and 6 each in New Hampshire and Maine, according to U.S. Department of Justice statistics.

“I recognize that our job is, insofar as it’s possible, to keep everybody safe. It’s a very tall order,” Wall said. “Our record is very good. But we work with a very difficult population on a number of fronts, including mental health. Tragic outcomes can and do occur in all kinds of settings, correctional and hospital. I do not think it means that we, or I, am responsible for that outcome.”

Monday, June 15, 2009

“We tend to use a criminal justice model for a disease and it just doesn’t work,” Judge Stephen Leifman told me in a telephone conference earlier this year. “We can’t afford to keep doing what we’re doing.”

Leifman, a special adviser on criminal justice and mental health for the Florida Supreme Court, was talking about the financial and social costs of housing the mentally ill in municipal, county and state jails.

Of an estimated 600,000 Floridians with mental illness, about 125,000 needing immediate treatment are booked into jails or prisons each year. The cost for a mentally healthy inmate is about $40,000 per year. For a person with mental illness in a state-operated psychiatric hospital, the annual cost is about $140,000

In addition, the numbers are increasing and it’s estimated that over the next decade, the state would have to build a new prison each year to keep up with the number of mentally ill inmates.

And, that doesn’t include the costs for expanding county jails for their mentally ill populations, which has been occurring on the Treasure Coast in recent years.

Speaking recently at a briefing on Capitol Hill, Leifman said, “Our criminal justice system was never intended to be the safety net for the public mental health system. Unfortunately, though, that is exactly what it has become. Too often, people land in jail for minor offenses directly related to symptoms of untreated mental illnesses because of inadequate system of community-based services and supports.

“Only through systemwide collaboration and partnerships can we begin to close the revolving door to the criminal justice system which, today, results in increased recidivism, devastation to our families and communities, wasteful government spending, and the shameful warehousing in jails and prisons of some of the most vulnerable and neglected members of our communities.”

Leifman was speaking in conjunction with release of the first significant study of mental health and jails in about two decades. That study by the Council of State Governments Justice Center and Policy Research Associates found that about 17 percent of inmates in the study suffered from “serious” mental illness.

That study, however, looked at only about 20,000 inmates at five jails. Using those figures, it was estimated that about 2 million seriously mentally ill persons are booked into jails in the United States each year.

But, it’s not just those with serious mental illness who are being housed in jails. Based on medications required, about a third of those booked into the St. Lucie County Jail each year suffer from some form of mental illness. The cost for a mentally ill person charged with a misdemeanor averages $35,000 per stay. The cost for a mentally ill person charged with a felony is about $64,000 per stay.

In March, U.S. Sen. Jim Webb, D-Va., introduced the National Criminal Justice Commission Act of 2009, which calls for a national commission to undertake an 18-month study of the impact of putting the mentally ill in jail and how the criminal justice system can be reformed to address the problem.

U.S. Sen. Pat Leahy, D-Vt., has been pushing for reauthorization of the Mentally Ill Offender Treatment and Crime Reduction Act, which would provide federal grants to state and local governments to create or expand mental health courts, offer treatment and training programs to provide support and services to reduce repeat offenders, and to train police in how to react to situations involving persons with mental illness.

In addressing the results of its study, the Council of State Governments Justice Center said, “Too often there are people incarcerated who have serious mental illnesses, oftentimes for minor offenses, who would be better served in the community. Though jails have a constitutional mandate to treat the mental illnesses of individuals under their supervision, they are ill-equipped to meet the needs of those with serious mental illness.

“Policies have relied on outdated data to determine the scope and nature of this problem. As state and local governments face significant budget shortfalls, grapple with growing jail populations, and slash spending for community-based mental health services, there has not been a more critical time for policymakers to consider the implications of this prevalence study.”

Study results are clear. Too many people with mental illness are in jails who should not be there. They can be better served and more cheaply served through community programs.

But, as time goes on without comprehensive actions, those will mentally illness and their families are abused and taxpayers are forced to pay far more than they should for far too little.